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New Approaches in Sport Sciences (NASS), Vol 1, No 2, 77-92, December 2019
The Relationship between Body Composition with Blood Pressure
and Sleep Quality in Male Dormitory Student at
Allameh Tabataba'i University
Mehdi Kushkestani 1
Mohsen Parvani*
Shiva Ebrahimpour Nosrani
Seyed Yousef Bathaeezadeh
M.Sc. Student of Exercise Physiology, Faculty of Physical Education and
Sport Sciences, Allameh Tabataba’i University, Tehran, Iran
Received: November 14, 2019; Accepted: January 14, 2020
doi:10.22054/nass.2019.10536
Abstract Background and Pupose: Hypertension and poor sleep quality can increase the
risk of cardiovascular diseases, diabetes, stroke, etc. Therefore, the purpose of this
study was to investigate the relationship between body compositions with
hypertension and sleep quality in male students living in Allameh Tabataba'i
University dormitory. Material and Method: The present study was descriptive-
correlational. The statistical population consisted of 170 male dormitory students
of Allameh Tabataba'i University who were randomly selected. First, body
composition indices and blood pressure of subjects were measured and recorded.
Then, the Pittsburgh Questionnaire were completed by students (PSQI) to assess
their sleep quality. Data were analyzed using SPSS 21 software at a significant
level (P
78 Ali Mehdi Kushkestani, Mohsen Parvani, Shiva Ebrahimpour Nosrani, Bathaeezadeh, Seyed Yousef
INTRODUCTION High blood pressure is the most important risk factor for premature
mortality in all around the world (Kishi et al., 2015). In recent years, the
prevalence of hypertension has increased remarkably in different
societies. According to the World Health Organization report, the
number of people with hypertension has reached 1.13 billion worldwide
in 2019, whose more than 66% of them living in low-income countries
(Hypertension retrieved from WHO, 2019). In a meta-analysis study
conducted in 2019 in Iran, the prevalence of hypertension has been
reported 25%, which had a 3% increase in comparison to 2012 (Oori et
al., 2019).
Also, numerous studies have examined the relationship between
hypertension and various diseases. To clear more, the relationship
between high blood pressure with cardiovascular diseases (Ettehad et al.,
2016; Wells et al., 2015) kidney diseases (Patel et al., 2015),
cerebrovascular syndrome (Patel et al., 2015), stroke (Nyombi et al.,
2016), metabolic syndrome, diabetes, and dementia have been well
proven (Bloch, 2016).
On the other hand, graduation from high school and entering
University and living in dormitories is associated with many changes in
students’ lifestyle. In this period, factors such as being away from family,
having new roommate, lack of welfare, social and economic pressures
along with educational problems (Cleary, Walter, & Jackson, 2011) lead
to unhealthy behaviors and changes in lifestyle, which consequently
potentiate various diseases such as hypertension, sleep disorders,
cardiovascular disease, diabetes, and many other chronic diseases.
Commonly, sleep quality has decreased considerably due to changes
in human societies lifestyle, which is along with academic failure and
lower students' health quality (Kronholm et al., 2008). Previous studies
in this area have been shown that about 73 percent of students living in a
dormitory experience insufficient sleep, sleep disorders, or difficulty
falling asleep (Buboltz et al., 2009).
The results of different studies indicate that the decrease in sleep
quality and the increase in sleep disorders are being prevalent among
students and since the sleep disorder is one of the risk factors of
cardiovascular and metabolic diseases, addressing this issue, as well as
providing a medical strategy is an important action (Sin, Ho, & Chung,
Relationship between Body Composition with Blood Pressure and Sleep Quality … 79
2009; Suen, Ellis Hon, & Tam, 2008); because, it has been proven that
sleep disorders influence on human health by changing the rhythm of
hormone release, developing cardiovascular dysfunction, dyslipidemia,
metabolic syndrome, and a poor blood glucose regulation (Bixler, 2009).
Control and identification of factors influencing high blood pressure
and lower sleep quality are of great importance to improve the health
status of the community. Assessment of body composition and
anthropometric indices are of the simplest and most accessible methods
that do not need expensive laboratory equipment. Several studies have
examined the relationship between body composition and various
disease-risk factors. Moreover, studies have reported that there is a
positive correlation between hypertension with body mass index and fat
percentage (Deng et al., 2012) while there is a negative correlation
between hypertension and muscle mass (Ye et al., 2018). Furthermore,
researchers have examined the relationship between BMI and sleep
quality. In fact, there is a significant negative correlation between BMI
and sleep quality (Vargas, Flores, & Robles, 2014). Also, many studies
have reported that there is a significant negative correlation between
subcutaneous fat percentage and visceral fat with sleep quality while
there is a positive correlation between muscle mass and sleep quality
(Rahe, Czira, Teismann, & Berger, 2015). (Kahlhöfer, Karschin,
Breusing, & Bosy‐Westphal, 2016). Given the different lifestyles of dorm students and their vulnerability
to peers, as well as the necessity for a healthy lifestyle to prevent different
diseases throughout life, assessing risk factors such as body composition,
sleep quality and blood pressure are of great importance. Over the past
years, less research has examined the relationship between body
composition with high blood pressure and sleep quality in students to
prevent the development of cardiovascular diseases and early death.
Therefore, the purpose of this study was to investigate the relationship
between body compositions and hypertension and sleep quality of male
students living at the dormitory of Allameh Tabataba'i University.
80 Ali Mehdi Kushkestani, Mohsen Parvani, Shiva Ebrahimpour Nosrani, Bathaeezadeh, Seyed Yousef
METHOD
Subjects This was a descriptive correlational study conducted during August 2018
in a Hemmat male’s dormitory of Allameh Tabataba'i University.
Hemmat dormitory out of all dormitories belong to Allamah Tabatabai
was selected randomly. The sample size 168 with a 95% confidence
interval and 5% error was determined by the Cochran formula.
A total of 190 out of 300 subjects from all grades and disciplines
randomly participated in this study. Then the research aims were
presented precisely and all subjects signed the consent form. Also, the
researcher assured that subjects’ identity and what they say or do during
the research would be maintained confidential. The subjects'
characteristics were collected and recorded by a demographic
questionnaire.
The inclusion criteria included: students aged more than 18 years
who had given their consent for participation, and experience of living at
least 3 months in Allameh Tabataba’i University dormitory. Subjects
excluded if they reported any food consumption for at least 2 hours
before sampling, drinking alcohol or a large amount of water,
consumption of caffeine-containing substances such as coffee, doing
vigorous exercise on sampling day, and aged more than 40-year-old
(because of data normalization).
Six subjects were excluded from the study due to the incomplete
sleep quality questionnaire and 7 subjects due to the BMI lower than
15kg/m2 and measurement error by body composition analysis device 4
subjects due to the constant caffeine consumption and 3 other subjects
due to the doing vagarious exercise on the day of sampling. Figure 1
indicates the flow charts of the sampling procedure.
Relationship between Body Composition with Blood Pressure and Sleep Quality … 81
Figure 1
Anthropometric, body composition measurement The height and weight of subjects were measured and recorded by wall-
sticker tape meter and the OMRON digital scanner with 0.01 g sensitivity
respectively, with minimal clothing and no shoes. Waist circumference
was measured with non-stretching tape at mid-way between the anterior
superior iliac crest and the lowest rib. Hip circumference was measured
from the side at the greatest point of the buttocks to the nearest 0.1 cm.
Waist to hip ratio (WHR) was determined by the corresponding value of
waist and hip circumferences and classified into low and high-risk groups
according to cutoff point WHR>0.9 in men. Then, body composition
indices of subjects were measured and recorded by OMRON (BF511,
china) body composition analysis device in a 3-hour fasting state with
minimal clothing. Body mass index (BMI) was classified according to
the World Health Organization as 30 kg/m2 is
obese . Classification of body fat percentage (BFP) for male aged 18-39
was divided based on manual operation of OMRON Healthcare with
ranges of 25% very
high("BF511 body composition monitor," 2015). Also, skeletal muscle
mass percentage (SMMP) was classified as
82 Ali Mehdi Kushkestani, Mohsen Parvani, Shiva Ebrahimpour Nosrani, Bathaeezadeh, Seyed Yousef
normal, 39.4-44% high and >44.1% very high ("BF511 body
composition monitor," 2015).
Sleep quality assessment To evaluate the students' sleep quality, the Pittsburgh 18 items
questionnaire (PSQI) was used. The scoring of this questionnaire is in
the form of 3-point Likert scale. The total index of sleep quality
measuring by sum of the seven sub-scales. Gaining a score of over 5 in
the entire questionnaire means poor sleep quality (Buysse, Reynolds III,
Monk, Berman, & Kupfer, 1989).
Blood pressure assessment Subjects' blood pressure was measured after 10 minutes of rest at the
upper left arm in seated position by the OMRON (M2, Vietnam) pressure
gauge with an accuracy of 3 mmHg. Hypotension was considered as
systolic below 90 mmHg and diastolic below 60 mmHg. Normal blood
pressure was defined as 90-119 mmHg (SBP) and 60-79 mmHg (DBP).
Subjects with SBP of 120-139 mmHg and DBP of 80-89 mmHg were
classified as prehypertensive. Stage-I hypertension was considered as
SBP between 140-159 mmHg and DBP between 90-99 mmHg, whereas
systolic blood pressure of 160-179 mmHg and diastolic of 100-109
mmHg were classified as stage II hypertension. Hypertensive crisis was
determined systolic and diastolic blood over 180 mmHg and 110 mmHg
respectively.
Statistical analysis Data were checked for normality before proceeding to statistics analysis.
Descriptive statistics including mean ±standard deviation, frequencies
and percentages were used. Pearson correlation coefficient was used at
the significance level of (P
Relationship between Body Composition with Blood Pressure and Sleep Quality … 83
Table 1: demographic, anthropometric and blood pressure measurements
Variables Status Mean±SD N (%)
Age (years) 25.94±3.60
Height (cm) 177.55±6.51
Weight (kg) 75.46±11.38
BMI (kg/m2) 23.94±3.26
Normal 104 (61.19%)
Overweight 60 (35.29%)
Obese 6 (3.52%)
Fat percentage (%) 20.45±6.73
Low 6 (3.53%)
Normal 69 (40.59%)
High 45 (26.47%)
Very high 50 (29.41%)
Muscle mass (%) 39.21±3.91
Low 5 (2.94%)
Normal 89 (52.35%)
High 53 (31.18%)
Very High 23 (13.53%)
WHR 0.84±0.06
Low risk 151 (88.82%)
High risk 19 (11.18%)
SBP (mmHg) 119.97±11.35
Normal blood Pressure 85 (50%)
Prehypertension 78 (45.88%)
High blood pressure stage1 7 (4.12%)
DBP (mmHg) 75.94±8.89
Hypotension 5 (2.94%)
Normal blood pressure 109 (64.12%)
Prehypertension 45 (26.47%)
High blood pressure stage 1 11 (6.47%)
BMI: Body mass index, CV: cardiovascular, BP: Blood Pressure
84 Ali Mehdi Kushkestani, Mohsen Parvani, Shiva Ebrahimpour Nosrani, Bathaeezadeh, Seyed Yousef
The meanSD systolic and diastolic blood pressure of subjects was
119.97±11.35 mmHg and 75.94±8.89 mmHg, respectively; however, a
total of 78 (45.88%) of the subjects were found to be systolic
prehypertensive, and 45(26.47%) of total participants were found to have
diastolic prehypertension.
The results of Pearson correlation coefficient indicated a significant
positive correlation between BFP and BMI with both systolic and
diastolic blood pressures. In addition, the increase in diastolic blood
pressure was associated with an increase in WHR. On the other side,
there was a significant and negative correlation between muscle mass
and both systolic and diastolic pressure in the students. Also, body
composition indices did not show any significant correlation with
student's sleep quality (Table 2).
Table 1: The correlation between anthropometric and body composition
indices with blood pressure and sleep quality
Variables Fat percentage Muscle mass BMI WHR
Systolic BP P
r
+0.000**
0.281
-0.001**
0.252
+0.000**
0.297
0. 147
0.112
Diastolic BP P
r
+0.000**
0.357
-0.000**
0.356
+0.000**
0.322
0.011*
0.195
Sleep quality P
r
0.764
-0.023
0.846
0.015
0.933
0.006
0.906
0.009
* indicates p-value
Relationship between Body Composition with Blood Pressure and Sleep Quality … 85
other hand, in comparison to systolic blood pressure, the association
between body fat percentage and diastolic blood pressure was higher,
which was consistent with past findings(Moser et al., 2013; Mushengezi
& Chillo, 2014). It has been well established that high systolic blood
pressure has a significant effect on the incident and development of
cardiovascular and metabolic diseases. It has also been reported that an
increase in systolic blood pressure leads to an increased risk of
intracerebral hemorrhage (stroke caused by bleeding within brain tissue),
subarachnoid hemorrhage (the deadliest form of stroke), and stable
angina while high diastolic blood pressure is associated with increased
risk of Abdominal aortic aneurysm (Rapsomaniki et al., 2014). In
addition, it has been reported that high diastolic blood pressure also
increases the risk of high systolic blood pressure (Rapsomaniki et al.,
2014), so according to our findings (the potent association of body fat
percentage with diastolic blood pressure), it can be noted that our
subjects with high-fat percentages are at risk of many cardiovascular
diseases. Also, our findings indicated that 26.47% of students classified
in the high-fat percentage group and 29.41% in the very high-fat
percentage group. In fact, 55.88% of the students had fat percentage more
than the normal range, which is a very high rate and it can be stated that
the risk of hypertension, cardiovascular and metabolic diseases is high in
the students of Allameh Tabataba'i University. Our findings are in line
with (Wang et al., 2015). An increase in body fat percentage leads to a
rise in inflammatory adipokines secretion, which consequently leads to
disturbances in secretion and function of nitric oxide (it is very important
in regulating blood pressure and vascular function) and decreases its
serum levels (Kotsis, Stabouli, Papakatsika, Rizos, & Parati, 2010).
Reduction of nitric oxide disturbs endothelial function, resulting in
increased stiffness and arterial stenosis, which eventually increases the
arterial pressure (Chiolero, Cachat, Burnier, Paccaud, & Bovet, 2007).
In the present study, there was a positive and significant correlation
between BMI and students' blood pressure. Also, 38.81% of students
were overweight and obese (35.29% overweight and 3.52% obese),
which make them susceptible to various diseases such as type 2 diabetes
and cardiovascular disease. Our findings in this regard are in line with
Deng et al. (2012), Jayedi et al. (Deng et al., 2012; Jayedi, Rashidy-Pour,
Khorshidi, & Shab-Bidar, 2018). Regarding the strong and positive
86 Ali Mehdi Kushkestani, Mohsen Parvani, Shiva Ebrahimpour Nosrani, Bathaeezadeh, Seyed Yousef
relationship between BMI and body fat, it can be expected that BMI may
also increase blood pressure through mentioned direct and indirect
mechanisms. It has been reported that high BMI and obesity lead to the
adipokines release that is associated with a reduction in efficiency and
production of nitric oxide (Kotsis et al., 2010). Nitric oxide is important
in vascular dilatation and improvement of blood circulation, and its
reduction results in impaired endothelial function which leads to high
blood pressure (Chiolero et al., 2007; Kotsis et al., 2010)
In the present study, there was a negative and significant correlation
between muscle mass and students' blood pressure. Our findings in this
regard, is consistent with studies by Butcher et al. and Benjamin et al.
(Benjamin et al., 2017; Butcher et al., 2018). Possible mechanisms of
muscle mass effect on blood pressure include reduction of inflammatory
factors, improvement of antioxidant enzyme activity and renal function
(Butcher et al., 2018). It has also been reported that an increase in muscle
mass is often associated with a decrease in body fat percentage, leading
to an increase in myostatin (muscle growth inhibitor) inhibition, and
consequently results in cardiovascular health, glucose tolerance and
endothelial function which ultimately improves blood pressure.
There is a possible mechanism linking muscle mass with blood
pressure; to explain more, with an increase in muscle mass, Myostatin,
an inhibition factor of muscle growth is blocked, and consequently, it
enhances cardiovascular health, glucose tolerance and endothelial
function which ultimately leads to blood pressure improvement (Bergen
et al., 2015; Ruas et al., 2012).
In the present study, there was a significant positive relationship
between waist to hip ratio and diastolic blood pressure. Our findings are
in line with the study of Abbaszadeh et al. Factors such as impairment in
the renin-angiotensin system, increased stiffness of the arteries, and high
activity of sympathetic nervous system have been reported as the most
important factors in central obesity-related hypertension (Abbaszadeh et
al., 2017).
In the present study, there was no significant relationship between
the body composition and sleep quality of dormitory students. Our
findings are contradictory to Zhou et al. and Jurado-Fasoli et al. (Jurado-
Fasoli et al., 2018; Zhou, Lalani, Banda, & Robinson, 2018). The
contradiction reason can be attributed to various factors. In the most
Relationship between Body Composition with Blood Pressure and Sleep Quality … 87
studies, the focus had been on the one or two subcategories of sleep
quality such as sleep satisfaction or sleep depth (Harvey, Stinson,
Whitaker, Moskovitz, & Virk, 2008), thus the difference in outcome can
be due to the different classification and assessing every single factor of
sleep quality. On the other hand, in most studies, the sample size were
more than 500 subjects, and this may be contributing to the different
results (Vargas et al., 2014). Also, the subjects' health status may have a
significant impact on the results. In the studies on the overweight, high
BMI and high-fat percentage subjects, there was a reverse correlation
between these factors and sleep quality (Ye et al., 2018; Zhou et al.,
2018). The differences in the subjects’ age may be another reason for
different results. Therefore, regarding the lack of correlation between
obesity and the sleep quality of students, ignoring this could endanger
individuals’ health in adulthood (Jurado-Fasoli et al., 2018).
CONCLUSIONS Regarding the wide range of effective factors on sleep quality of young
people, indices such as stress, physical activity level, nutritional status
and tobacco consumption would be more important indicators than the
body composition among dormitory students. The positive role of
physical activity to control blood pressure has been proven in many
studies, in which most of these studies have reported moderate-intensity
aerobic training is the best exercise to modify and control blood pressure
and body composition (Ahmed, Blaha, Nasir, Rivera, & Blumenthal,
2012; Boutcher & Boutcher, 2017; Tartibian, Kushkestani, & Nosrani,
2019). Furthermore, improving the diet such as reduction of sodium
intake, alcohol consumption, saturated fat intake, and the increase of
potassium, and the more consumption of natural and organic substances
can be considered as an effective strategy to improve the body
composition and prevent the onset of high blood pressure (Bazzano,
Green, Harrison, & Reynolds, 2013; Mohanlal, Parsa, & Weir, 2012).
Limitation As this was a cross-sectional study, it could not clarify the cause-effect
relationship between body composition with blood pressure and sleep
quality and also sample size was small. Blood pressure was measured
only once. It would be more accurate to measure the blood pressure three
88 Ali Mehdi Kushkestani, Mohsen Parvani, Shiva Ebrahimpour Nosrani, Bathaeezadeh, Seyed Yousef
times within an interval of at least five minutes and then used its average
in the analysis.
Finally, according to the direct relationship between fat percentage
and hypertension among students living in the dormitory, it can be
concluded that the use of exercise in leisure time and recreational
programs to improve body composition can play an important role in the
prevention and treatment of hypertension in their future.
Declaration of interest The authors declare that there is no conflict of interest.
Acknowledgment We would like to thank all students who participated in the study.
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